Been rehabbing the hell out of my achilles... still feels like crap after 6 weeks. What now?

I have recently recovered from insertional achillies tendinosis. Mine quickly improved in about 3 weeks and just about back to normal (no pain, stiffness is almost all gone) after 4. I kept running too... So here is how:

see this article (insertional):

http://www.runningwritings.com/2011/09/injury-series-flat-eccentric-heel-drops.html

and this article for mid-achillies pain:

http://www.runningwritings.com/2013/11/achilles-tendonitis-in-runners.html

things to do:

1. figure out if it is insertional or mid-achillies

2. stop stretching

3. do the appropriate heel drops; floor - inseretional, or off step for mid, see articles and follow the instructions in the articles for how to perform. do NOT do any concentric work on the bad leg!

So the article says to do the strength work 2x per day, but I only did the heel drops once per day after I ran. I did 2x15 reps of the variety standing on the floor as I had insertional pain. I started at 20lbs and over 3 weeks built up to 40lb. I'm still at 40lb and will bump it up to 42-45lb in the next few days. At this point I'll probably keep these exercises in the routine as maintenance work (I'll bring in the off a step work once I'm completely healed).

Go for the advice in the article to make the injured area ache just a little bit while doing this work. It is kind of unnerving, but even after 2 weeks I was noticing huge improvements,even though I only did the strength work once per day. My tendon pain was bad enough to make some runs really miserable and would cut workouts and long runs short, so I was in a pretty bad state.

Good luck

I should also note I also got massage and did self massage to keep the calf loose.

I also did the strength exercises barefoot (no shoes).

backintoit wrote:

I should also note I also got massage and did self massage to keep the calf loose.

I also did the strength exercises barefoot (no shoes).

Holy sh*t there is some bad stuff on here. Okay man, I went through this, it's normal for guys (although it does happen to women too). Here's the thing about the Achilles, it's different than other parts of your body, and responds to aggressive stimuli.

Eccentric calf drops (there is no such thing as an eccentric raise) are the ticket here, BECAUSE it is so aggressive. It should hurt, and when it starts getting less painful, add weight (backpack, huge dumbbells in hands, or press the door frame if have one above you) to make it harder. You have to keep the heat on that thing to really come all the way out of this.

When I went through this last spring, it took more than 6 weeks, and in addition to weeks of the drops, I ended up doing 1-2 workouts a week on the treadmill, 12% grade, in New Balance Minimus shoes, up to 2 hour workouts. That should snap an injured achilles in half. But instead, it recovered to 100% in time for summer racing. And btw, I was doing those uphill workouts when that thing was still hurting pretty bad. I could not do flat running workouts.

Don't listen to the RICE people, you will just get out of shape and the tendon will still hurt when you start up again.

LISTEN TO THE GUY ABOVE ME.

I have dealt with this for four years. I swore off eccentrics because I thought they didn't do anything, after trying them unweighted for twice a day, for 16 weeks.

Since I have tried everything, recently I decided to give it a go again and started doing WEIGHTED eccentrics. I use a backpack which I put weight plates in. I have worked my way up to doing 45 consecutive reps of single leg eccentric calf raises with 100lbs in the pack (hardest part is getting the pack on safely lol).

The difference is phenomenal. I have been doing this for 10 weeks now and am now up to almost 50 mpw with no pain. I can still feel some slight dysfunction but it is getting better by the day.

I'm doing nothing else other than eccentrics and self deep tissue massage. No stretching, no ice, no anti-inflammatories, staying active. Anything that could reduce blood flow to the tendon should be avoided at all costs.

AKMarmoset wrote:

Eccentric calf drops (there is no such thing as an eccentric raise) are the ticket here, BECAUSE it is so aggressive. It should hurt, and when it starts getting less painful, add weight (backpack, huge dumbbells in hands, or press the door frame if have one above you) to make it harder. You have to keep the heat on that thing to really come all the way out of this.

This is the dumbest advice ever, and probably why some people get ruptured achilles.

AJJ wrote:

Eccentric calf RAISES??? No no no no no no no. I have an achilles injury as well. You must do eccentric heel DROPS. Don't even use your injured leg to raise yourself up.

Exactly right! The OP has it exactly backward.

Find a stairwell with concrete steps. In running shoes--so that the "cleats" of the shoes lock on the edge of the steps--stand on the ball of the foot with the pained achilles and slowly lower the heel of that foot, letting the achilles be stretched as you go. Use your hand on the railing for support; also use your hand on the stairwell railing. Drop as far as you can. Some pain is good--it's important, in fact. Hold it for five seconds at the point where the pain is bearable. Then use your hand and your GOOD leg to raise yourself back up to where you started from. Do NOT use your bad leg/achilles to raise yourself back up. If you do that, you're doing exactly the opposite of what you're supposed to be doing.

Do one set of 15 on that leg. Break them into three sets of 5 drops, and take a pause.

Do that daily for three months and you'll be fine. After one month, you may begin to notice some slight improvement. At this point, you can jog slowly for up to half an hour. Do NOT push the pace, and if you notice Achilles pain or tenderness, slow down even further.

After that first month, you can also begin to push the drop-stretch somewhat harder.

By the time you get to three months, there should be no pain whatever during the drops.

I went to a MD acupuncturist for a similar injury to my achilles 20 years ago.

It was the only thing that worked. It took four sessions over two weeks. Look seriously into this - note - my acupuncturist was an MD - and did not overpromise.

I would recommend going to a professional because there are a lot of things to consider when treating someone with an achilles, or any, tendonopathy. The real key is looking at it on a spectrum from a reactive (acute) tendinopathy to a chronic/degenerative tendinopathy... The former being one where relative rest and unloading techniques are beneficial to allow the tendon to heal, with the thought that the tendon is reacting to some overload of stimuli. In this case it's all relative as to whether your offloading is just a heel lift and a down week of running, or it's two weeks off running.

In the case of a more chronic/degenerative tendinopathy, that subjectively isn't a "hot, burning" type pain but rather this "old/stiff/crotchety" feeling tendons eccentrics are indicated. It's split down the middle whether you want to perform them into pain or not, I'll typically say no more than 5/10 pain that should resolve quickly after finishing. The literature cites 12wks at the timeframe for full resolution, so even if you feel better after a week or two it's generally a good idea to continue with the eccentrics. In the mean time you can be working on any other global weaknesses you have that theoretically could have contributed to the tendinopathy in the first place....

Long story short, everyone that posted before me on the right track, but it depends where you fall along that spectrum from acute to chronic.

I had an Achilles tear once and here's what I did:

Wrap it with a compression bandage to inhibit full range of motion, insert heel wedge in hiking boot, lace up boots, strap on heart rate monitor and hike half mile hill repeats for a week. Elevate and ice when at rest. BOOM! "Heeled!"

Only do the steps if your achilles issue is higher up. For insertional achilles issues (back of the heel), you want to do the heel drops on a flat surface so the heel does NOT drop below the toes.

Very important.

I never understand why people that haven't figured out how to overcome a problem give this kind of advice (bad) acting like they have the answer.

Wrong, heel drops SHOULD be done for insertional. But they should be done on a flat surface, and not off a step.

And, as others pointed out, you should not have been stretching an injured area.

No wonder your 4 wks of PT made it worse.

You are stuck in a cycle because the collagen fibers in your achilles are healing in an unhealthy, scrambled pattern. They heal in a weakened state, so whenever you start back up again, you are prone to reinjury. Without re-aligning those fibers, your 8-month cycle will turn into a multiple-year cycle. I guarantee it.

Do yourself a favor and order the book "Anatony for RUnners" by Jay Dicharry and follow his recommendations.

The eccentric heel drops with re-align the collagen fibers in the achilles over a period of about 6 weeks. Combine this with some concentrated self-massage ("tissue flossing" of any tight/sore areas in the soleus, calf, and hamstring muscles and you should break out the cycle you're in.

Avoid the anti-inflammatories too.

Ice is good.

And, I'd avoid that PT you were seeing. They clearly don't know what they're doing for this kind of an injury.

So let me get this straight. You're saying that it's good to perform eccentrics (below neutral for mid substance but to neutral for insertional), yet you can't stretch your calf? What do you think happens at the end of an eccentric at end range? You're stretching the area, try it. Even to neutral, you are likely putting a far greater load through that tendon than when you stretch. Also, if you're looking at risk factors for achilles tendonopathy, limited dorsiflexion is one of them. How do you resolve that? Stretching.. Eccentrics may help with improving ROM too but that's a different conversation. So if to have grossly limited dorsiflexion on your affected side, then stretch that. You are putting less load through the tendon than with other exercises so it's ok. Just don't stretch into significant pain. Also, you can't disregard the therapeutic effects of stretching, it generally feels good. So try light stretching for symptom relief, if it doesn't work ditch it.

Also, there actually is evidence for the addition of stretching in the treatment of patellar tendon tendiopathies. It's not the same tendon, but generally similar histlogical changes occur for both regions.

Stretch if you want!

El Stupido Loco wrote:

AKMarmoset wrote:

Eccentric calf drops (there is no such thing as an eccentric raise) are the ticket here, BECAUSE it is so aggressive. It should hurt, and when it starts getting less painful, add weight (backpack, huge dumbbells in hands, or press the door frame if have one above you) to make it harder. You have to keep the heat on that thing to really come all the way out of this.

This is the dumbest advice ever, and probably why some people get ruptured achilles.

I stand by it. I will say, everyone is different to some extent, but generally I think I'm on-track here. Obviously if the tendon is calcified or there are bone spurs or something freaky like that it could be different. If it's tendinosis, this is the way to go.

Do you have examples for the achilles rupture, on long slow incline workouts? Or the eccentric drops? Because I think you'll find that most of them actually come from fast explosive movements, e.g. hurdles racing in spikes etc.

Haha, only on LetsRun would someone try to argue that stretching and eccentric motion under load are comparable.

I'm not, I'm saying there is significantly less load with stretching. So how could that possible be harmful for an injury when you are advocating a treatment that far greater stress through the tendon? Any reasonable answer for that?

And if someone is far to irritable to tolerate eccentrics, but you want to put some type of low level tensile stress through a tendon how would you do that? Plus, you certainly are stretching the musculotendious unit at end range dorsiflexion with eccentrics... Unless you define stretching in some other way.

Yay, a new name for my junk

I had this injury about a year ago and at the time I didn't know how serious it was, so tried to run through it. It got to the point that it was painful to walk, and I stopped all activity. I found the eccentric heal drops / rest / advil.

Once the pain stopped from walking, I gradually started trying to run, but I would stop running immediately once I started experiencing any discomfort. At the beginning, I couldn't run more than half a mile without feeling pain. Eventually I worked myself up to a mile, then 2 miles. Once I could sustain 20 minutes of jogging without pain.

I found that putting these heal cups:

http://www.amazon.com/Tulis-Heavy-Duty-Large-175lbs/dp/B000MSZT7O/ref=sr_1_1?ie=UTF8&qid=1424710215&sr=8-1&keywords=heal+cups

in my shoes enabled me to return to activity a lot quicker.

It isn't so much the cushion but rather than it lifts your heal and thus doesn't put as much tension on your achilles. I see that others on this board have given the opposite advice -- to wear zero drop shoes -- but I actually experienced the exact opposite.

After a couple months I was mostly healed. Important to keep up the heal drops and other exercises to strengthen the tendon.

El Stupido Loco wrote:

AKMarmoset wrote:

Eccentric calf drops (there is no such thing as an eccentric raise) are the ticket here, BECAUSE it is so aggressive. It should hurt, and when it starts getting less painful, add weight (backpack, huge dumbbells in hands, or press the door frame if have one above you) to make it harder. You have to keep the heat on that thing to really come all the way out of this.

This is the dumbest advice ever, and probably why some people get ruptured achilles.

uh...no. Afredson thought this is what would happen when he started doing these. He *wanted* to tear his achilles so he could get surgery. But it turned out that it cured it which is why he went on to conduct the randomized trial of eccentrics.

They tried to make me go to rehab baby, No, No, No.